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Updated: Dec 25, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Population Pharmacokinetics of Cefoxitin Administered for Pediatric Cardiac Surgery Prophylaxis

Zaccaria Ricci1, Simona Benegni1, Jeffrey J Cies

  • 1From the Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

The Pediatric Infectious Disease Journal
|March 30, 2020
PubMed

Insights

Cefoxitin dosing during pediatric cardiac surgery with cardiopulmonary bypass needs adjustment, as concentrations can be suboptimal. Pharmacokinetic target attainment was over 90% for most children, but lower in older patients.

Area of Science:

  • Pharmacology
  • Pediatric Surgery
  • Critical Care Medicine

Background:

  • Antimicrobial pharmacokinetics (PK) during pediatric cardiac surgery with cardiopulmonary bypass (CPB) is variable.
  • Drug concentrations may be supra or subtherapeutic, impacting efficacy and safety.

Purpose of the Study:

  • To determine the population PK and pharmacodynamic target attainment (PTA) of cefoxitin in pediatric patients undergoing cardiac surgery with CPB.
  • To evaluate cefoxitin PK/PTA across different pediatric age groups.

Main Methods:

  • Prospective interventional study involving cefoxitin administration (40 mg/kg) before skin incision.
  • Blood samples collected throughout surgery; population PK and PTA analyzed in neonates, infants, and children (<10 and >10 years).

Main Results:

  • Cefoxitin levels decreased over time; concentrations fell below the target (8 mg/L) after 240 minutes.
  • Body weight, age, BMI, and creatinine influenced cefoxitin clearance; age, weight, and BMI affected volume of distribution.
  • PTA (>90%) was achieved in most groups, but was only 62% in patients >10 years old.

Conclusions:

  • CPB significantly influences cefoxitin PK, generally reducing drug clearance.
  • Adequate PTA was achieved in most pediatric patients, except for those >10 years or undergoing longer surgeries.
  • Cefoxitin dosing may require adjustments in specific pediatric populations during CPB surgery.
Abstract

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